Healthcare Provider Details

I. General information

NPI: 1629008222
Provider Name (Legal Business Name): ROBERT R MITCHELL PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 05/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9915 SANDIFUR PKWY
PASCO WA
99301-8941
US

IV. Provider business mailing address

229 LAUREL ST
WALLA WALLA WA
99362-2640
US

V. Phone/Fax

Practice location:
  • Phone: 509-546-2222
  • Fax: 509-546-2202
Mailing address:
  • Phone: 509-522-0133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA10003461
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: